DHEA, Pregnanolone, Allopregnanolone; A Convergence?

[KatieS]

Just a note of caution related to the cognitive impairment of gabapentin from my husband who was on 600mg nightly for years. He thinks it definitely had cognitive side effects and getting off the drug is described online as "worse than heroin". He calls it a "dumbing drug".

According to this reference (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229254/), gabapentin is most likely the least toxic and side effects are variable to the person. Still, we are so leary of drugs with potential cognitive issues, I would be take a miminal dose and observe carefully.

Also, anyone tested for sleep apnea should carefully review their actual sleep study. I was informed my home study was "normal" but had desats down to 82. Remember that normal can mean not breathing, choking up to 5 times per hour. Since apnea is defined as only 10 seconds, this would not result in oxygen desats, but for me, the apneas were much longer, hence the desats. Review how many apneas you have during deep sleep or REM, as this might be causing the awakenings. Once my husband's sleep apnea was treated, the insomnia issue resolved.

[circular]

Kitano can you remind me what home apparatus you are using? I have on my list to request a sleep study. I've been practicing mindfulness meditation while falling asleep. It's allowed me to become clear that some nights when I shift position a number of times while falling asleep, it's due to my airway cutting off. Note, I am very thin, middle aged female - not at all the "typical" apnea patient. I think this may be due to my laxity issues affecting tissues in my airway at night. Plus, I have to sleep on my back all night which is the worst position for apnea. Anyhoo, what's the apparatus you're using? TIA

[rep]

It appears Gabapentin (neurontin) was evaluated for anticholiergic cognitive effects but was not added to the list (see the 2nd page):

http://www.agingbraincare.org/uploads/p ... l_size.pdf

If anyone has an update on it I would love to see a link.

I do agree with Kitano. I have been on it at a dose of 2700 mg. per day in divided doses in the past for probably 10 years. It turned me into a sleepy zombie but I needed it for nerve pain and had no idea about my E4 status then. I have been placed on it again recently but have resisted taking the full dose and only take it at night to be able to sleep through the pain.

IF this has been re-evaluated since the link above and IS bad cognitively I need to know. It's not clear to me why they say it was reviewed but NOT added. My guess is that it did not prove out to be cognitively harmful but I wish they would state it explicitly.

[KatieS]

Rep, Neurontin (gabapentin) used to prescribed like candy for pain with success. However, I do think the long-term cognitive effects and withdrawal from the drug, might be why the Armed Services no longer use this drug.

Cir, I've been on CPAP about four years now. This was taken from one of my first post:

"There appears to be a strong association of being an E4 carrier and developing sleep apnea. Plus, if you are a carrier, the apnea is worse, even though you might not have the stereotypical signs of being at risk for sleep apnea (obese, large neck size, male).
http://www.ncbi.nlm.nih.gov/pubmed/12127169
http://www.alzforum.org/news/research-n ... entia-risk
In E4 carriers, unlike non-carriers, the sleep apnea was associated with lower cognitive tests.
http://www.researchgate.net/publication … 4_Carriers "

My lifetime BMI is 19 with a 24 inch waist, so sleep apnea would be dismissed, but the opening of my throat is narrow. My 97 y/o mom had the tonsils and uvula removed in childhood, probably saving her from the diagnosis.

[Silverlining]

Circ, my hospital sleep study diagnosed mild apnea (7 events per hour). They gave me an oral appliance but I have significant bite issues as well as tmj, so it's not going to fly. I'm going to advocate for a cpap. I'm small too and do not present as typical apnea patient. Kitano has been wonderfully helpful in dispensing excellent advice. Good Luck!

[KatieS]

Anyone can email me related to apnea. From my perspective, getting used to CPAP is not even close to the adjustment of intermittent fasting and other E4 dietary changes.

When I saw my EEG the next morning after the sleep study, I was shocked how flat the waves were despite severe desats. Comparing this to my 3/3 husband who's EEG was spiking rapidly with minor desats. It makes me wonder if the E4 brain becomes damaged, hence the apnea.

[AnneG]

Gilgamesh, Alysson, 300 mg. of gabapentin was effective for me for the 5 years I used it, with the exception of the last 5 months during which I increased it to 600 mg. because of high stress during that time. (If I recall correctly, my SNPs indicated being a slow metabolizer.) I experienced no detectable side effects. However, in titrating down, I was taking apart the tiny 100 mg capsule and cutting the content with a razor blade into quarters or fifths, staying at each level for 4 days to a week. Even then, nights were difficult. Looking at online forums, this level of sensitivity doesn't seem to be a problem for everyone, but it's a caution. One of my eventual concerns in continuing to use gabapentin was the possibility of its interaction with folate and B12, risking higher homocysteine. (Please excuse formatting, I haven't figured that out yet.)

"Treatment with most of the commonly used AEDs is associated with reduced folate or vitamin B12 serum levels and is a risk factor for hyperhomocysteinemia. Oral substitution is effective to restore vitamin, MCV, and homocysteine levels. Ann Neurol 2011."
http://www.ncbi.nlm.nih.gov/pubmed/21246600

International Journal of Preventive Medicine
Effects of Common Anti-epileptic Drugs on the Serum Levels of Homocysteine and Folic Acid
Zamzam Paknahad, Ahmad Chitsaz, [...], and Elham Sheklabadi
"CONCLUSION
Our data suggest that administration of AED alters the metabolism of Hcy and folic acid. Our contradictions in the insignificant data may be of sample size, on the other hand all the epileptic patients received VPA. Further studies with a larger number of subjects are needed."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399294/

Rep, I'm so sorry about your nerve pain and impact on your sleep. I expect you've been through every therapy in the book. 25 years ago I used amitriptylline 5-10 mg for a year for pain due to an undiagnosed ruptured disc, and that really did make me stupid. I remember standing stock still 5 minutes in a grocery store trying to remember what "butter" was, looking back and forth between items until an image of a cow made something go kachink. I sure was relaxed, though. For my niece, who has quadrilateral nerve pain from RSD/CRPS, neurofeedback was a huge help, learning to control her sympathetic and parasympathetic response.

[circular]

I just asked my doc whether he thought it would be safe for me to supplement my pregnenolone given it's very low status. He said he'd supplement with DHEA instead. He seemed to think there could be good reason to do that, with a relative absence of evidence supporting pregnenolone supplementation. He also emphasized how much all the hormones fluctuate during the day and between days, making one-shot tests generally not too helpful. But he did say it would be safe to use DHEA or pregnenolone, suggesting for a post-meno woman 10-25 of DHEA would be fine, and if adding pregnenolone he seemed to lean about the same amount. If I'd asked him specifically whether amounts over 25, or even up to 100 which I've seen online, would be safe, I'm not sure what his opinion would be. I've always liked that his thinking seems to straddle functional and allopathic medicines, which isn't to say his view is definitive if someone else is discovering things he may be unaware of.

I'm curious whether there are brain-specific effects of pregnenolone that might be independent of its role in manufacturing DHEA (haven't had time to see what's out there on that).

[Kathleen1]

Both my pregnenolone 151 (ref range 15-132 ng/dl) and my DHEA 8.7 (ref range o.6-4.7 ng/dl) are elevated. No symptoms. I sailed through menopause over a decade ago. No sx but my doc wants to repeat in a few months given the elevated numbers. Needless to say, I am not supplementing, but do not know if this buys me any protection.

[Silverlining]

Wanted to chime in on a new private lab I found, Request A Test. I've been low in dhea-s in the past and I'm feeling like I could benefit from a small supplementation, but wanted a baseline draw before I start. I ordered a dhea sulfate test this morning for 43.12...good price with a current coupon I found online. Their base price ($49) was less than private md labs ($71.99) and direct labs ($68). They draw through the same local lab (LabCorp) that the other private labs use.

Edit: George, the reason you're taking gingko biloba is because you don't want dhea to convert to estrogen, however, I do/would want that conversion...that's the reason women take HRT, for estrogen, right? So, I should not take gingko biloba. I am not currently on any HRT; it takes months to get into my doctor for hormones. So, in the meantime, I'm wanting relief from menopause symptoms, hence the DHEA. I tried dhea a couple of years ago and I believe it did convert to estrogen; I noticed signs within two days of taking it, so I stopped since I didn't want excess estrogen at that time....